South African AIDS Expert Urges Circumcision

By CLARE NULLIS, Associated Press WriterSeptember 25, 2005

A South African AIDS expert Saturday advocated male circumcision as the best available "vaccine" against the virus in his country, where an estimated 6 million people are infected and more than 600 people die every day.

Francois Venter told a congress of health activists in the Treatment Action Campaign that a recent survey in the Soweto township indicated that circumcised men were 65 percent less likely to contract AIDS than those who had not been circumcised.

"We dream of a vaccine which has this efficacy," said Venter, clinical director of the Reproductive Health and HIV Research at the University of Witwatersrand. "The results are phenomenal."

The association between circumcision and a reduced risk of HIV was noted as early as 1987, when Dr. William Cameron of the University of Manitoba in Canada reported findings from a study in Kenya. Some researchers in early studies have said they believe cells in the foreskin may be particularly susceptible to infection.

Venter urged the Treatment Action Campaign, an influential movement of 13,000 activists, to consider promoting circumcision as a vital prevention tool, given that existing methods were failing to slow the spread of the epidemic.

South Africa has the highest number of people living with HIV/AIDS in the world. Nearly 30 percent of pregnant women are infected, according to a health department survey published in July, and in the hardest hit province of KwaZuluNatal this rises to 41 percent. The disease is now one of the main causes of death among young adults and infants.

Some traditional communities in South Africa practice circumcision, but there are calls for tighter medical controls to limit health risks from blunt and contaminated instruments.

"We don't want our men to go to the chop shop but have medical circumcision," said Zackie Achmat, an AIDS activist who said the congress — which meets every two years — would debate whether to encourage mass circumcision.

Achmat, who is HIV positive, said much more needed to be done on prevention. He said that even though government distribution of condoms increased from one million in 1994 to 40 million in 2004, this still only amounted to 35 condoms per sexually active male per year.

He said that 73 percent of young people without the virus believed that they were not at risk of catching, and 62 percent of young people with the virus also believed there was no risk.

Achmat criticized the government's record on treatment. Of the 500,000 people who need AIDS therapy, only 76,000 are currently receiving it through the public health sector. The World Health Organization has singled out slow progress in South Africa as one of the main reasons it will likely miss its target of putting 3 million people worldwide on therapy by the end of this year.

"We are dying. We are still dying," he said.

Achmat has for years attacked the government for doing too little too late against the AIDS epidemic. In a sign of the mutual antagonism, health ministry officials refused invitations to attend the congress.

"President Thabo Mbeki tragically still shows symptoms of AIDS denialism," said Achmat. Mbeki reputedly doubts the link between HIV and AIDS. Health Minister Manto Tshabalala-Msimang has repeatedly voiced doubts about the safety and efficacy of antiretrovirals, instead stressing the benefits of a diet heavy in garlic, lemon and olive oil.

The Soweto study, was conducted by French researchers between 2002 and 2005 with more than 3,000 healthy, sexually active males between 18 and 24. About half the volunteers were circumcised by medical professionals, and the rest remained uncircumcised.

All the men received counseling on AIDS prevention. But after 21 months, 51 members of the uncircumcised group had contracted HIV, the AIDS virus, while only 18 members of the circumcised group had gotten the disease.

The World Health Organization and UNAIDS welcomed the results of the study, released at a conference in Brazil in July, but says that more trials should be conducted before circumcision can be recommended as a preventive method.

A study conducted by the U.S. National Health Institute involving 5,000 individuals is now under way in Uganda.